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Posted: November 29, 2008

A Life Up in Smoke

Is Quitting Only a Pipe Dream for Elderly Smokers?

For late-life smokers and family caregivers who are concerned about them, here is the good news: First, it’s never too late to quit. Second, quitting smoking reaps health benefits no matter when one quits smoking – and almost immediately.

But the “good news” is tempered with the hard reality that nicotine is a highly addictive substance, making quitting a very difficult task -- even in view of the fact that cigarettes contain more than 4,000 chemicals, many of which are highly toxic and some of which are increase the risk for cancer.

Julia Cartwright, senior vice president of communications for the American Legacy Foundation, a collaborative effort of national health organizations, 14 states, various non-profits, foundations and corporations dedicated to helping people to stop smoking, has seen the impact of smoking within her own family.

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“Both my mother and father began smoking in the 1930’s and 40’s,” she recalled. “My father started at age 14 and smoked right up to his death at 80 years of age. He smoked despite having a diagnosis of chronic obstructive pulmonary disease (COPD) and vocal chord cancer. Even when he said he had quit, we knew he still smoked. You could smell it on his clothes and in the bathroom where he’d smoke with the window open.”

Caregivers Affected Too

But the problem of smoking goes beyond its effect on the smoker’s health and extends to the entire family, as Kathleen Comunetti, a family caregiver, can attest. Comunetti and her family moved to Southern California to lend a helping hand to her aging, ailing mother. Now five years later, Comunetti says, “I can honestly say I never expected it to be this long, and the price we’re paying in terms of getting on with our own lives is exponentially higher than I ever expected it would be.”

Like Cartwright, Comunetti grew up in a household with two chain-smoking parents. Her mother’s smoking began when she was an Army nurse in WWII and was supplied with free cigarettes.

Comunetti says even as a child that she felt sick constantly due to her exposure to smoke in the home. With a history of asthma, Comunetti says her worst attacks are those triggered by cigarette smoke.

Caregivers like Comunetti who are exposed to secondhand smoke have reason to be concerned. Studies show there is no safe level for exposure to second hand smoke. Individuals exposed to secondhand smoke are at the same risk as smokers for heart disease, lung disease, cancer, and cardiovascular disease.

Smoking Seniors Can Influence Kids

Comunetti is fully aware of the bitter irony of her situation. She was at first concerned about her mother’s health, but now sees the risks not only to her own health and her husband’s but especially that of her three sons.

“All of my sons have been attracted to smoking since a young age,” she said. “But having lived with their grandmother has made it much easier for them to get cigarettes, and it’s going to make it much harder to encourage them to quit.”

Attempts to elicit cooperation from her mother in setting “no smoking” zones in the home have proven to be unsuccessful. She says, “We’ve tried confining the smoking to her bedroom, using fans, closing doors, but the fact remains that we’re living in her home and she does what she wants because it is her house.”

When smokers have been smoking for decades, is it really possible to kick the habit?

All evidence points to the fact that older smokers have as much chance as anyone else to become ex-smokers. According to Cartwright, the typical ex-smoker has made an average of eight to 10 attempts at quitting before succeeding. And older adults seem to have very good results when they use “telephone quit lines” combined with use of a smoking cessation aide, such as nicotine gum, patches, or lozenges.

Considering Their Future

Dr. Paul Cincirpini, deputy chair of the Tobacco Research and Treatment Program of M.D. Anderson Cancer Center of Houston, says late-life smokers might challenge themselves by these three thoughts:

1. Ask yourself: How do I want to spend the last 10 years of my life?

2. Acknowledge that your quality of life will improve when the guilt and cost of smoking are no longer issues in your life.

3. It’s proven that ex-smokers reduce their risk of complications with health problems, new or existing.

Cincirpini says caregivers should not underestimate the addictive power of nicotine, and he also points out that smokers are more prone to have a history of depression, anxiety disorder or substance abuse than non-smokers.

“Nicotine is a pyscho-active drug that affects the neurotransmitters that modulate our moods,” he said. “That’s one reason why quitting is so difficult without some use of nicotine replacement therapy. But when people attempt to quit smoking, they are giving themselves an opportunity to learn how to become a non-smoker, and their chances will be better if withdrawal from nicotine is managed.”

Medical-Family Teamwork Helps

Cincirpini advises smokers to talk with their primary physician about the health risks or benefits related to use of nicotine therapy aides or medications, if an individual is using insulin, anti-asthmatics or Coumadin (warfarin).

Cincirpini says family members can make a positive contribution to helping a loved one to quit smoking through exposing smokers to the opportunities and tools available to quit. Those opportunities and tools include use of hotlines, support groups, and nicotine replacement aides.

While it may not be easy to find the balance between being supportive and being a nagging presence when it comes to the issue of a loved one’s smoking, Cartwright offers this advice: “Caregivers who want to help a family member need to avoid making attributions of blame, anger or fault. It’s very hard to avoid assigning blame and being angry, but those very feelings will put caregivers at risk for not being able to provide optimal care.”

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Paula S. McCarron has more than 20 years of experience in health care, including nursing homes and hospice. She lives in Chelmsford, Massachusetts, and can be reached at paulamccarron@gmail.com.

RESOURCES:

If you or your loved one need help quitting smoking, check out these resources:

1-800-QUIT. A free telephone hotline offering “coaches” and help in developing an effective and realistic plan to quit smoking. Sponsored by the US Department of Health and Human Services.

Become an EX. Sponsored by the American Legacy Foundation and the National Alliance for Tobacco Cessation, EX offers an online resource where smokers can build a personal plan to quit smoking as well as join support groups offered via the EX website at www.becomeanex.org.

Nicotine Anonymous (NA). Modeled after Alcoholics Anonymous, this is a free program for those seeking nicotine-free lives, including those using cessation programs and nicotine withdrawal aids. Call toll free (877) 879-6422 or visit www.nicotine-anonymous.org.

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